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2107 6th Street SW, Canton, Ohio 44706 • (330) 452-8271

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E-Z Re-enrollment Form 2011

Please complete this form and turn in required payment by Monday, May 2, 2011 to qualify for early re-enrollment VIP plan.

Section 1

This form is for RE-ENROLLMENT. If you wish to enroll for the first time, please click enrollment on the main menu, or contact the main office at (330) 452-8271.

Parent Name

Address

City

State

Zip

Home Phone

Email Address

Father's Employer

Father's Employer Phone

Father's Cell Phone

Mother's Employer

Mother's Employer Phone

Mother's Cell Phone

Emergency Names/Numbers/Relationship to Student

Church Family Attends

Church Address

Pastor

Youth Pastor

Section 2

Will the student be using public school transportation if available?

Yes
No

Please select the student's public school district

Will K-5 student be using before/after school Extended Day Program (Super Room) New forms must be filled out every year. Pick up forms in Main Office

Yes
No

I give my full consent to HCS to publish and copyright all photographs in which my child(ren) appear(s): (yearbook, newsletters, website, newspaper articles, promotional materials, etc.)

Yes
No

I give my full consent for my child to go on school-sponsored field trips.

Yes
No

List names of all children re-enrolling for 2011-2012 & the grade they are entering:

Section 3

Families that pay the year's tuition in full by Friday, July 15, 2011 will receive a 3% discount. Prepayments are made in the HCS Main Office.

Tuition Payment Options

Prepaid
Automatic Withdrawal
Invoicing

Annual Set-up Fees: $45 for a Monthly Invoicing Agreement or $38 for Automatic Withdrawal. Families currently using Automatic Withdrawal or Invoicing Agreements will be automatically re-enrolled in FACTS. Please contact the HCS Tuition Office if bank or payer information has changed. Those families choosing Invoicing agreement will have a payment date of the 1st of each month.

Automatic Withdrawal

On the 5th of the month
On the 20th of the month

Payment Frequency

One Payment - due July 15
12 Months - due July thru June
11 Months - due Aug. thru June
10 Months - due Sep. Thru June
4 Months - due Aug Nov Feb & May

Name of person who will be responsible to pay tuition

Is/Are your student(s) renewing an Ohio EdChoice Scholarship?

Yes
No

If yes, a renewal form must be submitted to Heritage along with proof of your current address. (For those families, the necessary renewal form is available in the Main Office and is also available online at www.edchoice.ohio.gov.)

Section 4

Fundraising Requirement

Please add $300 per student to my tuition, as I wish to opt out of participating in the fundraisers.

Yes
No

Yes, I will cover the $300 per student shortfall by actively participating in any or all school-wide fundraisers: the Heritage Hike/Bowl-a-thon, the Jubilee Card Sale, the Candy Sale and/or giving to the Annual Fund. (TRIP credits may be used for fundraising obligations.) Families are responsible for this amount before final report cards will be released.

Yes
No

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